Impacts of Coordinated, Hospital-wide Use of Alcohol-based Nasal Decolonization on Infection Rates, Patient Care and Cost Savings

Abstract

BACKGROUND To optimize infection rate reduction and increase safety and quality of care in our patients, in April 2016 we initiated a two-phase process to unify Infection Prevention (IP) protocols involving nasal decolonization across our 311-bed Community Hospital. Trial of an alcohol-based nasal decolonizing antiseptic in orthopedic, spine, and breast surgeries transitioned to its use in all surgeries by June 2017. In the second phase, begun in April 2017, alcohol-based nasal decolonization of all adult in-patients was initiated. METHODS In the year prior to the trial, surgical IP included pre-/post-operative chlorhexidine gluconate (CHG) bathing and pre-operative nasal decolonization with povidone iodine. By June 2017, surgical protocol changes were completed, in which pre-operative iodine was replaced by pre-/post-operative alcohol-based nasal decolonization. Starting in April 2017, all adult inpatients and new admissions received daily nasal decolonization and contact precautions (CP) for methicillin-resistant Staphylococcus aureus (MRSA)-colonized patients were discontinued. Decolonization compliance was monitored through the pre-op checklist and daily work-list. RESULTS In the 17 months following replacement of pre-operative iodine with pre- and post-operative alcohol-based antiseptic starting in June 2017, Staphylococcus aureus surgical site infection (SSI) rates decreased by 50.7% from 0.148/100 to 0.073/100 (P = 0.08), compared to the one-year pre-replacement baseline. In the 19 months following hospital-wide in-patient nasal decolonization, CP use decreased by 39%, while maintaining low rates of MRSA bacteremia. Work-list audits of nasal antiseptic compliance in May-June 2017 and January 2018 showed rates of 96% and 97%, respectively. Annualized savings of $223,150, net of decolonization costs, were estimated from CP, screening and SSI cost reductions. CONCLUSIONS Hospital-wide use of the alcohol-based nasal decolonizing agent to reduce the risk of nasal carriage-associated infections resulted in SSI rate reduction beyond the prior iodine-based protocol and improved nursing-care patient accessibility and cost-savings through reduction in CP use.